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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~~~T <br />ANNUAL FEE and REPORT REQUEST <br />/Hard Rock Paving &Redi-Mix, Inc. <br />~I-1977-196 <br />Buena Vista Pit <br />April 21, 2007 <br />y"ti .oy <br />°% ^ °n ~0 zdo, <br />°~on o <br />Migine ana Satejy'oa• <br />$$688.00 (Due on or before your anniversary date) <br />Chaffee <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shadsubmit-the-ammai-fee,-a-report-and-map_showing_the~xtent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur --- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the urevious year's man are necessary, then no new man is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make arty necessary <br />changes: <br />Pennittee Contact: Denise Gonzales <br />Permittee Name: Hard Rock Paving &Redi-Mix, Inc. <br />Address: P.O. Box 1720 <br />Canon City, CO 81215-1720 <br />Phone Number: (719) 275-1280 <br />Fax Number: (719) 275-8897 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />t%.~//~ <br />Signa of Corporate Officer, Owner, or Designee <br />~~~ <br />Date <br />